Question 4 is a citizen-led ballot question that will enable therapeutic access to natural psychedelic medicines that show promise in treating mental health conditions.

The measure creates a regulated framework for supervised use with trained facilitators at licensed psychedelic therapy centers and removes criminal penalties for limited personal use. It requires participants to undergo safety screenings prior to receiving psychedelic therapy services and does not legalize retail sales or storefronts. Here’s how it works:

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Frequently Asked Questions

When will voters decide Question 4?

Election Day is Tuesday, November 5th. Voters can also vote by mail beginning in October, and early in-person voting begins October 19. Be sure to check your voter registration status.

Why do we need access to natural psychedelic medicines?

Many people in Massachusetts are struggling with a mental health condition, including military veterans with PTSD, first responders and health care workers who face extreme levels of stress on the job, and patients with terminal illness who experience severe anxiety and depression when confronting the end of life.

Existing treatments—such as daily medications and traditional talk therapy—help some people. But for many, these tools aren’t working. Research from leading medical institutions shows natural psychedelic medicines is a breakthrough treatment that can significantly improve outcomes for people with PTSD, major depression, severe anxiety, OCD, headache disorders, and other difficult to treat health conditions.

What are natural psychedelic medicines?

Natural psychedelic medicines are naturally-occurring compounds that show promise for treating mental health conditions. Question 4 includes four natural substances that have been an important part of indigenous cultures for many centuries: psilocybin (found in certain species of mushrooms), mescaline (found in certain species of cacti), DMT (found in several plants that are native to South America), and ibogaine (found in iboga, a shrub that grows in parts of Africa).

Medical experts agree that natural psychedelic medicines are non-addictive. In fact, there is substantial evidence that natural psychedelic medicines can be helpful in treating substance use disorder. Furthermore, the safety risk profiles of natural psychedelics are significantly lower than other commonly-used substances.

Will Question 4 allow retail sales and storefronts?

No. Regulated natural psychedelic medicines will only be administered at approved locations under the supervision of a licensed facilitator. Products cannot be purchased and taken home.

When will natural psychedelic therapy services become available?

Question 4 requires a two-year implementation and rule-making process prior to the opening of psychedelic therapy centers. Regulators will issue licenses to facilitators and psychedelic therapy centers by September 2026.

What kinds of regulations will the Natural Psychedelic Substances Commission create?

Question 4 directs the Commission and Advisory Board to develop rules related to:

• training programs, educational and experiential requirements, different tiers of licensing, and qualifications for facilitators that protect participant safety;
• requirements for holding and verifying completion of a safety screen, preparation session, administration session, and integration session;
• scope of practice for facilitators;
• a complaint, review, and disciplinary process for facilitators who engage in misconduct;
• educational materials, health and safety warnings, and informed consent documentation for participants;
• requirements for laboratory testing of substances for dosage and lack of contaminants;
• procedures and policies that allow for group administration sessions;
• recordkeeping, privacy, and confidentiality requirements;
• security requirements for service centers;
• requirements to ensure access to regulated natural psychedelic substances is affordable, equitable, ethical, inclusive, and culturally responsible;
• protections for indigenous and traditional practices; and 
• best practices that advance safety and reduce harm of use that remains outside the regulated system.

Will group therapy be permitted?

Yes. Question 4 authorizes the Natural Psychedelic Substances Commission to develop a framework to allow both individual and group therapy services.

Where else has this been done?

Oregon and Colorado voters have approved ballot questions to allow natural psychedelic medicine therapy.

How does the policy ensure safety?

Question 4 is grounded in public health and safety. Specific provisions to promote safety and reduce risks include:

• Guidelines for the development of content and scope of educational campaigns related to natural psychedelic substances;
• Development of a safety screening to assess if psychedelic services are appropriate for an individual and create an off-ramp for individuals at high risk for adverse outcomes (e.g., people with a history of psychosis or individuals currently taking lithium);
• Requirements for qualifications, training, and education for facilitators focused on mental and physical health;
• Health warnings and informed consent relating to contraindications and other risks;
• Tiers of licensure for facilitators to establish higher standards and qualifications to protect participant safety; and
• Reporting and publication of information pertaining to outcomes to measure success, safety, quality, and impact on individuals’ well-being and public health.

Will there be professional and ethical standards for psychedelic facilitators?

Yes. The Natural Psychedelic Substances Commission is charged with developing professional responsibility standards and education related to ethics. Facilitators who violate professional standards will be disciplined and possibly lose their license.

How much will the program cost and how will it be paid for?

Based on the costs of similar programs in Oregon and Colorado, the cost of administering the program will be in the low millions of dollars per year. Oregon’s psilocybin services program administered by the Oregon Health Authority has a yearly budget of roughly $3 million. By comparison, the annual state budget for Massachusetts is around $50-60 billion. The cost of administering the psychedelic therapy program under in Massachusetts under Question 4 will be offset by licensing fees and other collections related to the program.

How much will it cost for a person to receive psychedelic therapy services?

The cost of psychedelic services is similar to traditional mental health counseling. Licensed facilitators spend a minimum of 10 hours (often more) with each client before, during, and after the therapy. Service centers in Oregon are offering group sessions starting at $750 per person, while one-on-one services range between $1,200 and $1,800. Philanthropic foundations are helping lower costs for veterans and other people with financial hardships. Regulators and leaders in the field of psychedelic therapy are exploring ways to ensure that cost is not a barrier to access.

Where can I read the Massachusetts Attorney General’s summary of Question 4?

https://www.mass.gov/doc/final-summary-petition-23-13-version-a/download